Executive MBA - Coles College of Business - Kennesaw State University

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By filling out and submitting this form you will be able to download a PDF version of our brochure.

Please note that only the fields marked with a red asterisk (*) are required. However, answering the optional questions will help us make the information we send to you more relevant.

First Name:
*

Last Name:
*

Organization:

Title:

Home Address:

City:

State:

Home Zip or City Code:

Work Zip or City Code:

Country:

E-mail:
*

Work Phone:
*

Home Phone:

Mobile Phone:

Total years of full-time work experience?
0-4
5-9
10-15
16+

What degrees do you currently hold? (Please check all that apply)
Doctorate level degree (academic)
M.D., medical doctor degree (physician)
J.D., (lawyer)
Masters level degree (academic)
Undergraduate (non-business degree)
Undergraduate (business degree)
Other:

What are your current professional aspirations? (Please check all that apply)
Increasing my managerial judgment and executive decision making skills
Becoming a more effective leader or manager
Advancing within my current organization
Starting or growing my own business, practice, non-profit organization or franchise
Changing my current profession or functional job area
Other:

Below please find several general concepts or ideas. Please rank in order the top 3 concepts (where 1 is most important) as they relate to your personal life.

1	2	3
			Personal direction or life planning, knowing the direction of my life
			Family life
			Understanding and using my natural talents and abilities
			Self confidence, having confidence in myself
			Thriving in everything I do
			Spirituality
			Personal network, developing strong relationships with others
			Other:

Below please find several general concepts or ideas. Please rank in order the top 3 concepts (where 1 is most important) as they relate to your professional life.

1	2	3
			Authentic Leadership, understanding how to become an effective leader or lead without losing my sense of self
			Functional Teaming, understanding how to be a part of or lead a functional team
			Global experience, understanding and participating in a global business environment
			Executive level decision making, understanding how to use business tools, frameworks, and instruments to make and share executive level decisions
			Business acumen, best practices, strategy, insights and general business know-how
			Industry knowledge (e.g., Telecom industry knowledge)
			Presentation and communication acumen
			Other:

Does your employer offer tuition reimbursement?
Yes, Full reimbursement
Yes, Partial reimbursement
Unsure
No

Have you taken the GMAT (Graduate Management Admissions Test)?
(Note: Select applicants may qualify for a GMAT Waiver.)
Yes, if yes please provide score
No

Would you be interested in information about our GMAT Refresher courses that have been proven to remove pre-GMAT jitters?
Yes
No

What is your current base salary level?
$150,000+
$100,000-$149,000
$80,000-$99,999
$60,000-$79,999
$40,000-$59,999
Under $40,000

How did you learn about the Coles Executive MBA?
Browsing the web
Station - NPR, Public Broadcasting Network
Radio Station - 680 the Fan
Alumni or Current Student Referral, please list name:
Faculty, Staff or Board Member Referral, please list name:
Billboards
Airline Article (Air Tran or Delta)
Business to Business Magazine event or article
Article in the news (WSJ, Financial Times, NY Times, Atlanta Business Chronicle, AJC)
Hispanic MBA Fair
Galleria Digital Billboard
Jezebel Magazine
Other, please list: